On Wednesday, May 31, 2023, less than 4 months after the catastrophic train derailment in East Palestine, Ohio, the Healthcare Coalition of Southwestern Pennsylvania (HCSWPA) hosted a full-scale emergency preparedness exercise that focused on the same type of disaster.  The exercise tested the emergency plans of local healthcare providers that included long-term care and personal care facilities across Southwestern Pennsylvania.  Vincentian nursing homes and personal care homes participated in the full-scale exercise that followed a similar sequence of events as the February train incident. 

The scenario of the HCSWPA full scale exercise was based on the following real-life events: On February 3, 2023, a train derailment occurred in nearby East Palestine, Ohio that involved 38 tanker cars, 10 of which were carrying toxic chemicals.  Several of the cars were already leaking as a result of the derailment, with the other tanker cars threatening to leak or explode due to the ensuing fire.  Officials decided to initiate a controlled chemical release to mitigate the explosion and fire hazard and aid in the clean-up efforts.  Prior to the release of the chemicals, residents in nearby areas were advised to shelter in place.  However, when it was decided by authorities to initiate the controlled release, residents within an approximately 2 mile radius were ordered to evacuate.  Residents were kept away from their homes until authorities deemed the area safe.  The exercise scenario as provided by HCSWPA was a train derailment located within 2 miles of the healthcare facility.  The derailed cars were on fire and releasing large amounts of toxic smoke and chemical vapor that was drifting towards the facility.  The fire was expected to burn for hours and there was a risk of further chemical release. 

Participating Vincentian facilities were provided with the above scenario to start the exercise and over the course of the next 2.5 hours, were provided with additional action items.  The initial scenario and the subsequent action items required the facility leadership to utilize their All Hazards Plan to guide them through the simulated disaster.  The All Hazards Plan is an emergency response plan that contains useful information that is facility specific combined with standard operating procedures that apply to all Vincentian facilities.  The Plan is flexible and broad enough in scope to apply to a wide array of emergency situations.  In many emergency situations, the primary and preferred course of action is to defend in place.  This means that Vincentian facilities are equipped to shelter both residents and staff for a minimum of 72 hours.  Shelter in place is made possible by the emergency preparedness training provided to Vincentian staff along with the presence of critical supplies and vendor emergency supply agreements.  These elements allow for Vincentian facilities to operate as near to normal as possible. 

Vincentian leadership is trained to continually evaluate the developing emergency to make real-time decisions to ensure the continued safety of residents and staff.   The All Hazards Plan serves as a guide for many of these decisions.  During the exercise, Vincentian leaders were asked to evaluate their facility for any impact related to the simulated train derailment that was located within 2 miles of their facility.  Immediate issues to consider were the presence of toxic smoke, travel restrictions and the retention of staff.  Long term considerations were the continuity of operations under the evolving disaster scenario and the ultimate decision to continue to shelter in place or to evacuate the facility.  Facility evacuation is considered the last resort due to the complexities involved in transferring nursing home and personal care home residents to appropriate facilities.  If Vincentian was to evacuate a facility, there would be many intricate details to account for including resident transportation, family communications, pharmacy coordination, staff allocation, and a host of other details that are needed to provide care for our residents no matter where they are located.

The HCSWPA-sponsored full scale exercise served as a valuable learning opportunity for the participating Vincentian facilities.  A successful exercise should provide the opportunity to both succeed and fail.  Vincentian facilities found that while their All Hazards Plan was useful in dealing with the train derailment scenario, there were parts of the Plan that could be reinforced or updated.  Focusing on these failures and shortcomings is an essential part of any emergency preparedness exercise.  Going forward, Vincentian will continue to participate in regional exercises as part of its continual emergency preparedness efforts.